People who choose high-deductible health plans are not necessarily young and healthy. In fact, many earn low incomes, have poor-to-fair health and likely choose high-deductible plans for their lower premiums without understanding the high out-of-pocket expenses they could incur.

As a result, high deductible health plans go beyond cutting down use of unnecessary medical care. They discourage low-income people from getting needed preventive, primary care and subspecialty care.

Those are among the findings of Robert Graham Center researchers who looked at the impact of different types of high deductible plans on use of primary, preventive health care. The study, "Privately insured adults in HDHP with higher deductibles reduce rates of primary care and preventive services," was published in the June issue of Translational Behavioral Medicine.

Researcher Anuradha Jetty, MPH, and her colleagues investigated the impact of different high deductible plans on the use of primary and subspecialty services. The high-deductible plans they studied comprised those with no deductible costs, those with low deductibles, those associated with health savings accounts, and those that did not have health savings accounts.

Among their findings: people with high-deductible plans and no health savings accounts were least likely to use primary care, receive preventive care or seek subspecialty services. This group also were most likely to have low income and be in poor-to-fair health.

"We found that rates of breast cancer and hypertension screening, and flu vaccination were lower among respondents in high-deductible without health savings accounts compared with those enrolled in no-deductible insurance plans," Jetty writes. "...High-deductible-No-HSA enrollees reported slightly worse health status than other insured groups. Importantly, they visited primary care physicians less often and used fewer prevention services than the individuals in no-deductible plans.... These high-deductible-no-HSA enrollees defer needed medical care and are at greater risk of chronic diseases and their complications so could most benefit from lower cost, more prevention counseling, and disease screening visits of primary care providers."

Insurance companies should ensure their subscribers understand their high-deductible policies offer preventive care services that have no out-of-pocket expenses, Jetty and her colleagues write.

They also call for insurance regulation that required companies to establish deductibles on a graduated, income-related scale. Changes to the Affordable Care Act should preserve cost-free prevention coverage and low-cost primary care services "to assure that those of lower socioeconomic status can access primary care for prevention, early detection of chronic disease, and avoidable progression of chronic disease."